Sunday, September 14, 2003

With budget woes in both Georgia and Alabama, cuts are going to have to be made. With Medicaid taking up a good deal of both states' budgets, cuts will come from this as well. One of the favorite methods of doing this is to cut reimbursement to physicians. This is much easier than cutting back on eligibility. Why?
From a numbers standpoint, there are more consumers of medical care (and Medicare/Medicaid) than providers. Some of those consumers (the elderly) are very involved politically. Others (children, the disabled) have interest groups which do an effective job advocating for them. Politicians by their nature are not eager to offend large numbers of well-motivated voters.
Additionally, the perception of all doctors as "rich" makes reimbursement cuts more tasteful.
Another reason, in my opinion, is that the responsibility a physician feels toward their patients creates an unlevel playing field.
...More than anything, I realize, I have chosen to practice medicine to be part of my patients' lives and to treat them as thoroughly as I can. If I change this essential approach, I may jeopardize their health, not to mention my identity as a physician. True healers cannot look constantly at dollar signs.....
Insurance executives and politicians have no such qualms. Physicians were maligned in West Virginia and Pennsylvania (where the Attorney General threatened the licenses of physicians who were considering walking out). I don't think that the sentiment is wrong, it's why I do what I do. But the ideals that serve as the basis of that statement won't pay for my rent, staff salaries, or my liability insurance. Most physicians practices are small businesses, and are subject to the same forces as any small business, with the execption that we cannot pass on our cost increases to our "customers". (For additional ranting see my earlier post)
One thing that gives policy-makers pause about cutting reimbursement is that currently, participation by physicians is voluntary. If a physician makes a determination that they cannot continue to accept Medicare or Medicaid from an economic standpoint, they may opt out. This raises the possibility that if reimbursement is too low, physicians will opt out in enough numbers that access will become a problem.
"If we just saw Medicare patients and didn't see anyone with regular insurance, we wouldn't be able to pay the bills," said Dr. James E. Kurtz, an internist at Chatham Crossing Medical Center in Pittsboro, N.C. ....
Elsewhere, many doctors are refusing to see Medicare patients. "Some counties in Washington have no doctors who take new Medicare patients," Dr. Douglas Paauw, a professor of medicine at the University of Washington, said

But those in South Florida don't have that luxury.
Doctors in South Florida do not have a choice. Private insurers there pay the same as Medicare or less, and so many old people live in the area that if doctors want to practice, they must accept them. But how to make a living?
This is one problem that I have with a single-payer system of health insurance. If the government is the only game in town, without any competition, our options would be limited, and we would be at the mercy of people who have never taken the Hippocratic oath.
Thanks to DB for the links.
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